The present disclosure relates to skirted hernia repair devices which includes at least a first mesh layer having a first side, a second side, and an outer peripheral edge, a skirt mesh layer positioned on the first side of the first mesh layer, the skirt mesh layer having an inner peripheral edge defining an opening in the skirt mesh layer, and, at least one reinforcement member that prevents the skirt mesh layer from inverting.
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9. A skirted hernia repair device, comprising:
a first mesh layer configured to extend across a tissue opening, the first mesh layer having a first side and a second side;
a skirt mesh layer positioned on the first side of the first mesh layer forming a pocket therebetween, the skirt mesh layer having an inner peripheral edge and an outer peripheral edge, the inner peripheral edge defining an opening in the skirt mesh layer;
a plurality of reinforcement members fixedly attaching the first mesh layer to the skirt mesh layer to prevent the pocket from inverting, the plurality of reinforcement members including a first pair of first and second reinforcement members each having a first end extending from the inner peripheral edge of the skirt mesh layer to the outer peripheral edge of skirt mesh layer, wherein the second ends of the first and second reinforcement members of the first pair are closer to each other than the first ends of the first and second reinforcement members of the first pair.
1. A skirted hernia repair device, comprising:
a first mesh layer configured to extend across a tissue opening, the first mesh layer having a first side and a second side;
a skirt mesh layer positioned on the first side of the first mesh layer forming a pocket therebetween, the skirt mesh layer having an inner peripheral edge and an outer peripheral edge, the inner peripheral edge is continuous and defines an opening in the skirt mesh layer;
a seam attaching the first mesh layer to the skirt mesh layer at or near the outer peripheral edge of the skirt mesh layer; and,
a plurality of distinct reinforcement members positioned intermittently around the inner peripheral edge, the plurality of reinforcement members fixedly attaching the first mesh layer to the skirt mesh layer to prevent the pocket from inverting, wherein the plurality of reinforcement members are free of the inner peripheral edge and free of the outer peripheral edge, wherein the skirt mesh layer is spaced apart from the first mesh layer along the pocket creating a void therebetween, the void being positioned on both sides of the plurality of reinforcement members and extending to the opening.
2. The skirted hernia repair device according to
3. The skirted hernia repair device according to
4. The skirted hernia repair device according to
5. The skirted hernia repair device according to
6. The skirted hernia repair device according to
7. The skirted hernia repair device according to
8. The skirted hernia repair device according to
10. The skirted hernia repair device according to
11. The skirted hernia repair device according to
12. The skirted hernia repair device according to
13. The skirted hernia repair device according to
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This application is a continuation of U.S. patent application Ser. No. 14/453,640 filed Aug. 7, 2014, which claims benefit of and priority to U.S. Provisional Patent Application No. 61/883,450 filed Sep. 27, 2013, and the disclosures of each of the above-identified applications are hereby incorporated by reference in their entirety.
The present disclosure relates to hernia repair devices and, more particularly, to reinforced skirted mesh for use in hernia repair.
Hernias may be caused by defects in the muscle layer of the abdomen. Historically, attempts to reconstruct the abdominal wall muscles have been associated with a high recurrence rate.
Implantable devices for repairing hernia have been known for many years. They may be used to repair damaged tissue and to provide structure for supporting surrounding tissue.
The most basic form of device that can be used for hernia repair is a piece of mesh or any other flexible flat material that is strong enough to be affixed to the surrounding damaged tissue.
The key objective of a hernia repair procedure is to patch the hernia defect and to reinforce the surrounding weak muscle layer.
A number of mesh designs and techniques have been introduced to allow surgeons to improve the outcome of hernia repair procedures and to avoid some of the common complications.
Skirted hernia repair devices have become somewhat popular because they offer added strength and a lower recurrence rate, as compared to the older non-skirted repair devices.
However, the major challenge presented by the skirted hernia repair devices is the difficulty of maintaining the skirted repair device flat in the field, until it is properly secured to the surrounding tissue. More specifically, skirted hernia repair devices may be easily inverted, i.e., turned inside-out, prior to and/or during implantation, and more specifically, while a surgeon attempts to secure the skirted device to the tissue.
It would be beneficial to provide reinforced skirted hernia repair devices that are less likely to be inverted prior to and/or during implantation and more specifically, while a surgeon attempts to secure the skirted device to the tissue.
In accordance with one embodiment of the present disclosure, a skirted hernia repair device having multiple skirted sections is provided. The skirted hernia repair device includes a first mesh layer, a skirt mesh layer and at least one reinforcement member. The first mesh layer includes at least a first side, a second side, and an outer peripheral edge. The skirt mesh layer is positioned on the first side of the first mesh layer, and the skirt mesh layer includes an outer peripheral edge and an inner peripheral edge. The inner peripheral edge of the skirt mesh layer defines an opening in the skirt mesh layer. At least one reinforcement member connects the first mesh layer to the skirt mesh layer. The reinforcement member is positioned near the inner peripheral edge to prevent the skirt mesh layer from inverting.
In another embodiment, a skirted hernia repair device is described which includes a first planar mesh layer, a skirted section, and a plurality of reinforcement members. The first planar mesh layer has a first side, a second side and an outer peripheral edge. The skirted section is located on the first side of the first planar mesh layer near the outer peripheral edge. The plurality of reinforcement members connect a portion of the pocket to the first planar mesh layer to prevent the pocket from inverting.
Methods of using the skirted hernia repair devices are also described. In one embodiment, a method for repairing a tissue defect is described which includes: providing a skirted hernia repair device, positioning the skirted hernia repair device within a tissue defect such that a first mesh layer extends across the defect; and, securing the skirted hernia repair device to tissue. The skirted hernia repair device includes a first mesh layer, a skirt mesh layer, and at least one reinforcement member that connects the first mesh layer to the skirt mesh layer to prevent the skirt mesh layer from inverting. The first mesh layer includes a first side, a second side, and an outer peripheral edge. The skirt mesh layer is positioned on the first side of the first mesh layer; the skirt mesh layer includes an inner peripheral edge defining an opening. At least one reinforcement member that connects the first mesh layer to the skirt mesh layer to prevent the skirt mesh layer from inverting.
Various embodiments of the present disclosure are described herein with reference to the drawings wherein:
The present disclosure describes skirted hernia repair devices. The term “hernia repair devices” is not intended to be limited to devices suitable strictly for hernia repair but rather is intended to include any procedure, i.e., open, laparoscopic, endoluminal, intravaginal, NOTES, etc., for the repair of hernias, prolapses, fistulas, stomas, and the like. In particular embodiments, the skirted repair devices described herein may be used in intraperitoneal onlay procedures, and more particularly, open intraperitoneal onlay procedures.
Turning now to the figures, embodiments of the present disclosure are described in detail with reference to the figures wherein like reference numerals identify similar or identical elements.
As illustrated in
As further depicted in
As illustrated in
As depicted in
In addition to using reinforcement members, or as a substitute for the reinforcement members, the skirt sections may be formed by ultrasonic welding or using adhesives to bond the skirt mesh layer 220 to first mesh layer 210 at discreet locations such as those where a reinforcement member would be positioned.
In embodiments, as further depicted in
As depicted in
Still referring to
Turning now to
In embodiments, as depicted in
Any biocompatible material may be used to form the skirted hernia repair devices described herein, including the first mesh layer, the skirt mesh layer and the reinforcement members. For example, the first mesh layer and the skirt mesh layer may be made from natural, synthetic, bioabsorbable and/or non-bioabsorbable materials. It should of course be understood that any combination of natural, synthetic, bioabsorbable and non-bioabsorbable materials may be used to form the first mesh layer and the skirt mesh layer described herein.
The term “bioabsorbable” as used herein is defined to include both biodegradable and bioresorbable materials. By bioabsorbable, it is meant that the materials decompose, or lose structural integrity under body conditions (e.g. enzymatic degradation or hydrolysis) or are broken down (physically or chemically) under physiologic conditions in the body such that the degradation products are excretable or absorbable by the body.
Representative natural bioabsorbable materials include: polysaccharides, such as alginate, dextran, chitin, hyaluronic acid, cellulose, collagen, gelatin, fucans, glycosaminoglycans, and chemical derivatives thereof (substitutions and/or additions of chemical groups, for example, alkyl, alkylene, hydroxylations, oxidations, and other modifications routinely made by those skilled in the art); and proteins, such as albumin, casein, zein, silk, and copolymers and blends thereof, alone or in combination with synthetic polymers.
Synthetically modified natural polymers include cellulose derivatives, such as alkyl celluloses, hydroxyalkyl celluloses, cellulose ethers, cellulose esters, nitrocelluloses, and chitosan. Examples of suitable cellulose derivatives include methyl cellulose, ethyl cellulose, hydroxypropyl cellulose, hydroxypropyl methyl cellulose, hydroxybutyl methyl cellulose, cellulose acetate, cellulose propionate, cellulose acetate butyrate, cellulose acetate phthalate, carboxymethyl cellulose, cellulose triacetate, and cellulose sulfate sodium salt. These are collectively referred to herein as “celluloses.”
Representative synthetic bioabsorbable polymers include polyhydroxy acids prepared from lactone monomers, such as glycolide, lactide, caprolactone, ε-caprolactone, valerolactone, and δ-valerolactone, as well as pluronics, carbonates (e.g., trimethylene carbonate, tetramethylene carbonate, and the like), dioxanones (e.g., 1,4-dioxanone and p-dioxanone), 1,dioxepanones (e.g., 1,4-dioxepan-2-one and 1,5-dioxepan-2-one), and combinations thereof. Polymers formed therefrom include: polylactides; poly(lactic acid); polyglycolides; poly(glycolic acid); poly(trimethylene carbonate); poly(dioxanone); poly(hydroxybutyric acid); poly(hydroxyvaleric acid); poly(lactide-co-(ε-caprolactone-)); poly(glycolide-co-(ε-caprolactone)); polycarbonates; poly(pseudo amino acids); poly(amino acids); poly(hydroxyalkanoate)s; polyalkylene oxalates; polyoxaesters; polyanhydrides; polyortho esters; and copolymers, block copolymers, homopolymers, blends, and combinations thereof. In certain embodiments, the first mesh layer and/or the skirt mesh layer may be formed using a combination of bioabsorbable and non-bioabsorbable polymers.
Some non-limiting examples of suitable non-bioabsorbable materials include polyolefins, such as polyethylene and polypropylene including atactic, isotactic, syndiotactic, and blends thereof; polyethylene glycols; polyethylene oxides; ultra high molecular weight polyethylene; copolymers of polyethylene and polypropylene; polyisobutylene and ethylene-alpha olefin copolymers; fluorinated polyolefins, such as fluoroethylenes, including expanded polytetrafluoroethylene (ePTFE) and condensed polytetraflouroethylene c(PTFE), fluoropropylenes, fluoroPEGSs, and polytetrafluoroethylene; polyamides, such as nylon and polycaprolactam; polyamines; polyimines; polyesters, such as polyethylene terephthalate and polybutylene terephthalate; aliphatic polyesters; polyethers; polyether-esters, such as polybutester; polytetramethylene ether glycol; 1,4-butanediol; polyurethanes; acrylic polymers and copolymers; modacrylics; vinyl halide polymers and copolymers, such as polyvinyl chloride; polyvinyl alcohols; polyvinyl ethers, such as polyvinyl methyl ether; polyvinylidene halides, such as polyvinylidene fluoride and polyvinylidene chloride; polyacrylonitrile; polyaryletherketones; polyvinyl ketones; polyvinyl aromatics, such as polystyrene; polyvinyl esters, such as polyvinyl acetate; copolymers of vinyl monomers with each other and olefins, such as ethylene-methyl methacrylate copolymers, acrylonitrile-styrene copolymers, ABS resins, and ethylene-vinyl acetate copolymers; alkyd resins; polycarbonates; polyoxymethylenes; polyphosphazine; polyimides; epoxy resins; aramids, rayon; rayon-triacetate; spandex; silicones; and combinations thereof
The skirted hernia repair devices, including at least the first mesh layer and the skirt mesh layer, may be formed using any method within the purview of those skilled in the art. Some non-limiting examples include, weaving, knitting, braiding, crocheting, extruding, spraying, casting, molding, and combinations thereof. In some embodiments, the first mesh layer and the skirt mesh layer may be a two or three dimensional surgical mesh which is woven, knitted, braided, or crocheted from at least one first filament to form the layer. The at least one filament may be a monofilament or a multifilament.
In embodiments, the first mesh layer and the skirt mesh layer may be formed separately and combined along a seam using any suitable technique including weaving, knitting, braiding, crocheting, molding, suturing, welding, ultrasonics, gluing, and the like.
In embodiments, the first mesh layer and the skirt mesh layer may be initially formed as a single layer of mesh which is folded inwardly near the outer perimeter of the single layer of mesh to form the skirt mesh layer. The folded skirted mesh may be further processed to maintain the skirt mesh next to the first mesh layer in an overlapping position near the outer peripheral edge of each layer. Examples include thermosetting, ultrasonics, welding, pressing, knitting, braiding, weaving, crocheting and the like.
As depicted in the figures provided herein, the surface area of the first mesh layer is greater than the surface area of the skirt mesh layer. However, when the surface area of the first mesh layer is at least 1.5 times the surface area of the skirt mesh layer, the skirt mesh layer is more likely to be inverted during implantation and/or handling. In embodiments, the skirted hernia repair devices described herein include a first mesh layer having a surface area that is at least 1.5 times the surface area of the skirt mesh layer. In embodiments, the skirted hernia repair devices described herein include a first mesh layer having a surface area that is at least twice the surface area of the skirt mesh layer.
The reinforcement members described herein may be made from any biocompatible material, including the non-limiting exemplary list of natural, synthetic, bioabsorbable and/or non-bioabsorbable materials provided hereinabove. It should of course be understood that any combination of natural, synthetic, bioabsorbable and non-bioabsorbable materials may also be used to form the reinforcement members described herein.
The reinforcement members of the skirted hernia repair devices described herein may be formed using any method within the purview of those skilled in the art. Some non-limiting examples include, weaving, knitting, braiding, crocheting, extruding, spraying, dipping, casting, ultrasonics, welding, molding, and combinations thereof. In embodiments, the reinforcement members are filaments that fixedly attach the first mesh layer and the skirt mesh layer in the vicinity of the inner peripheral edge and/or the pocket. In embodiments, the reinforcement members are polymeric materials or tabs that fixedly attach the first mesh layer and the skirt mesh layer in the vicinity of the inner peripheral edge and/or the pocket. It is envisioned that a wide variety of other mechanical fasteners or fixtures may also be suitable for use as the reinforcement members. For example, in embodiments, the reinforcement members may be two part mechanical fasteners which are not fixedly attached, but rather can optionally be unattached when needed, such as the use of snaps, buttons, magnets and the like. In such embodiments, one part of the two part fastener may be positioned on the first mesh layer and the second part of the two-part fastener may be positioned on the skirt mesh layer.
In embodiments, the skirted hernia repair device may include at least one additional layer. For example, in embodiments, the skirted hernia repair device may further include an adhesion barrier film which prevents the ingrowth of tissue between the barrier film and the layer(s) of mesh material. In embodiments, as illustrated in
Methods of using the skirted hernia repair devices are also described. In one embodiment, a method for repairing a tissue defect is described which includes: providing a skirted hernia repair device, positioning the skirted hernia repair device within a tissue defect such that a first mesh layer extends across the defect; and, securing the skirted hernia repair device to tissue. The skirted hernia repair device includes a first mesh layer, a skirt mesh layer, and at least one reinforcement member that connects the first mesh layer to the skirt mesh layer to prevent the skirt mesh layer from inverting. The first mesh layer includes a first side, a second side, and an outer peripheral edge. The skirt mesh layer is positioned on the first side of the first mesh layer; the skirt mesh layer includes an inner peripheral edge defining an opening. At least one reinforcement member that connects the first mesh layer to the skirt mesh layer to prevent the skirt mesh layer from inverting.
In another embodiment, a method for performing an intraperitoneal onlay procedure is described which includes: providing a skirted hernia repair device, positioning the skirted hernia repair device within a tissue defect such that a first mesh layer extends across the defect and optionally, an adhesion barrier positioned beneath the first mesh layer; and, securing the skirted hernia repair device to tissue. In embodiments, securing a skirt mesh layer of the skirted hernia repair device to the tissue. The skirted hernia repair device includes a first mesh layer, a skirt mesh layer, and at least one reinforcement member that connects the first mesh layer to the skirt mesh layer to prevent the skirt mesh layer from inverting. The skirted hernia repair device may optionally include an adhesion barrier. The first mesh layer includes a first side, a second side, and an outer peripheral edge. The skirt mesh layer is positioned on the first side of the first mesh layer; the skirt mesh layer includes an inner peripheral edge defining an opening. At least one reinforcement member that connects the first mesh layer to the skirt mesh layer to prevent the skirt mesh layer from inverting.
From the foregoing and with reference to the various figure drawings, those skilled in the art will appreciate that certain modifications can also be made to the present disclosure without departing from the scope of the same. While several embodiments of the disclosure have been shown in the drawings, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. Therefore, the above description should not be construed as limiting, but merely as exemplifications of particular embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.
Russo, Mark, Worthington, Raylene
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